Campbell Paul, Hill Jonathan C, Protheroe Joanne, Afolabi Ebenezer K, Lewis Martyn, Beardmore Ruth, Hay Elaine M, Mallen Christian D, Bartlam Bernadette, Saunders Benjamin, van der Windt Danielle A, Jowett Sue, Foster Nadine E, Dunn Kate M
Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele.
Health Economics Unit, University of Birmingham, Birmingham, UK.
J Pain Res. 2016 Oct 14;9:807-818. doi: 10.2147/JPR.S116614. eCollection 2016.
Musculoskeletal conditions represent a considerable burden worldwide, and are predominantly managed in primary care. Evidence suggests that many musculoskeletal conditions share similar prognostic factors. Systematically assessing patient's prognosis and matching treatments based on prognostic subgroups (stratified care) has been shown to be both clinically effective and cost-effective. This study (Keele Aches and Pains Study) aims to refine and examine the validity of a brief questionnaire (Keele STarT MSK tool) designed to enable risk stratification of primary care patients with the five most common musculoskeletal pain presentations. We also describe the subgroups of patients, and explore the acceptability and feasibility of using the tool and how the tool is best implemented in clinical practice. The study design is mixed methods: a prospective, quantitative observational cohort study with a linked qualitative focus group and interview study. Patients who have consulted their GP or health care practitioner about a relevant musculoskeletal condition will be recruited from general practice. Participating patients will complete a baseline questionnaire (shortly after consultation), plus questionnaires 2 and 6 months later. A subsample of patients, along with participating GPs and health care practitioners, will be invited to take part in qualitative focus groups and interviews. The Keele STarT MSK tool will be refined based on face, discriminant, construct, and predictive validity at baseline and 2 months, and validated using data from 6-month follow-up. Patient and clinician perspectives about using the tool will be explored. This study will provide a validated prognostic tool (Keele STarT MSK) with established cutoff points to stratify patients with the five most common musculoskeletal presentations into low-, medium-, and high-risk subgroups. The qualitative analysis of patient and health care perspectives will inform practitioners on how to embed the tool into clinical practice using established general practice IT systems and clinician-support packages.
肌肉骨骼疾病在全球范围内造成了相当大的负担，且主要在初级医疗保健中进行管理。有证据表明，许多肌肉骨骼疾病具有相似的预后因素。系统地评估患者的预后并根据预后亚组匹配治疗方案（分层护理）已被证明在临床和成本效益方面均具有优势。本研究（基尔疼痛研究）旨在完善并检验一份简短问卷（基尔STarT MSK工具）的有效性，该问卷旨在对患有五种最常见肌肉骨骼疼痛症状的初级医疗保健患者进行风险分层。我们还将描述患者亚组，探讨使用该工具的可接受性和可行性，以及如何在临床实践中最佳地应用该工具。研究设计为混合方法：一项前瞻性定量观察队列研究，并结合定性焦点小组和访谈研究。已就相关肌肉骨骼疾病咨询过全科医生或医疗保健从业者的患者将从全科医疗中招募。参与研究的患者将完成一份基线问卷（咨询后不久），以及2个月和6个月后的问卷。将邀请部分患者子样本以及参与研究的全科医生和医疗保健从业者参加定性焦点小组和访谈。基尔STarT MSK工具将根据基线和2个月时的表面效度、区分效度、结构效度和预测效度进行完善，并使用6个月随访数据进行验证。将探索患者和临床医生对使用该工具的看法。本研究将提供一个经过验证的预后工具（基尔STarT MSK），其具有既定的临界点，可将患有五种最常见肌肉骨骼症状的患者分为低风险、中风险和高风险亚组。对患者和医疗保健人员观点的定性分析将为从业者提供信息，告知他们如何使用既定的全科医疗信息技术系统和临床医生支持包将该工具融入临床实践。
